Neither Dyane Harwood nor I are medical doctors. Please see a psychiatrist for psychotropic medications and to discuss medication changes. Medication of psychiatric illnesses requires the expertise of a psychiatrist. In my opinion, serious mental illnesses, such as bipolar disorder and schizophrenia, are best treated with medication by board certified psychiatrists. Supportive psychotherapists should be expert in working with our populations. We need more specialized support than, say, relationship counseling.

I know you wrote that you’ve tried pretty much everything…I’m so sorry —but I wonder if you’ve tried an MAOI (monoamine oxidase inhibitor) with lithium? I’m medication-resistant & I have bipolar one disorder. Over the past decade I tried 25+ other meds and I opted for unilateral and bilateral ECT (which worked for my acute bipolar depression with suicidal ideation). I have seen at least 20 psychiatrists and not ONE ever suggested to me to try the following medication that I describe below…

My latest psychiatrist (and the best one I’ve seen) suggested that I try the “old-school” medication of a MAOI (monoamine oxidase inhibitor) Parnate for my bipolar one, in combination with lithium. I did some research and found that MAOI’s are suggested to those with medication-resistant bipolar disorder. They have food and dietary restrictions that are more than worth the sacrifice to me, i.e. no alcohol and no foods containing high amounts of the amino acid tyramine. MAOI’s can work even more effectively in combination with lithium. (Two small studies done back in the 1970’s proved that hypothesis and I was impressed with the study results.)

The MAOI and lithium combo. finally worked to alleviate my longtime bipolar depression. I’m so thankful to these medications for helping me get my quality of life back. If even one person is helped by this comment, I’ll be thrilled.

47 thoughts on “Medications: To have or not, that is the question! | International Bipolar Foundation”

Different things work for different folk, but there’s a good reason doctors don’t recommend MAOIs so often these days. They are harder to manage (i.e. you have to diligently restrict your diet and keep a close eye on interactions with other meds) and are deadly in overdose (it can take up to 24 hours for an overdose to have a noticeable effect and then it’s often too late). They also aggravate other addictions – notably to nicotine.

Cabrogal I adore you and I adore your rabbits even more, but I disagree with you vehemently!

The dietary restrictions are TOTALLY DO-ABLE!

The doctors think their patients are TOO STUPID to comply!

MOREOVER, as MAOI’s (and lithium, of course) is an OLD-SCHOOL MEDICATION,
the doctors want you to buy their HIGH-PRICED, HOT-OFF-THE-SEXY-DRUG-REP’s hands
NEW drugs! Not something that has been around forever!!!

SO WHAT? You give up alcohol and certain foods high in tyramine – and you have to be careful what you eat. Read some labels. Ask some servers some questions.
NOT A BIG DEAL!
And the fatalities/overdoses from MAOI’s are RARE! I researched it….and so did my pdoc.

I SUFFERED FROM ACUTE SUICIDALITY and this med combo.
GOT ME TO STOP FEELING THAT WAY WITHIN TWO DAYS!

Kitt, if you’re reading this, I really think the world of Cabrogal, & we follow one another’s blogs,
but I can’t let Cabrogal’s comment deter anyone from giving this med a shot!!!!!!!!!

Plus SMOKING IS GROSS – LUNG CANCER from smoking
KILLED BOTH grandmothers and lung cancer is a HORRIBLE way to die.

I SAW THAT FIRSTHAND.

GIVE THAT CRAP UP!

I have no idea what other addictions are affected by MAOI’s aside from alcoholism –
again, you give up alcohol. I quit drinking cold-turkey in order to take the MAOI,
and I’m an alcoholic, because it was either give up the booze, or buh bye!

You have to put on your big boy/big girl pants and go to AA, people.
Sometimes you have to grow the fuck up. Especially if you have pets or children who rely on you to function.

Umm, dyane, without wishing to in any way denigrate your personal experience with MAOIs, don’t you think so insistently proselytising them and playing down the dangers is a little irresponsible?

Whatever your experience may be, many people would find cutting out alcohol, cheese, fava beans, etc pretty challenging – especially if they eat out a lot. They would also have to be very diligent about checking interactions with other drugs – including things like over the counter cough medicines. Failure to do either of those things could result in very damaging – even fatal – sudden onset of hypertension. I would assume that you aren’t susceptible to high blood pressure or your doctor would have been more wary of MAOIs, but you can’t assume that of others, nor that they see a doctor who is across the risks of MAOIs.

Even worse is the fact that all antidepressants – including MAOIs – have been associated with increased suicidality, especially in young people. It seems to me you lucked out with your response to them, but what do you suppose may have happened if they had increased your suicidal impulses – as they do for so many – while you were holding a bottle of very effective suicide pills in your hand? More than half of people with bipolar will attempt suicide at least once and it’s hardly a good idea to have a convenient and effective means in the medicine cabinet, especially if you fear that a family member may share your mental health problems (though I must admit that is less relevant in the US due to the prevalence of handguns).

I have no doubt that any recent research on fatalities associated with MAOIs is rare. That’s because MAOI use is now rare. Yes, fatal MAOI induced hypertensive crises were rare but strokes were not. Back in the 1970s MAOIs and tricyclic antidepressants were common means of suicide by psychiatric patients.

I know it can be hard to remember, considering the prescribing habits of US doctors, but NO antidepressants have ever been approved by the FDA to treat depression. In fact they are contraindicated due to strong clinical evidence that they worsen bipolar disorder in the medium to long term. Nonetheless 80% of medicated bipolar sufferers in the US use ADs and the rates of serious bipolar continue to rise, especially among young people.

The only related drug with FDA approval is a combination of Prozac and Zyprexa, with the latter aimed at suppressing the manic switching caused by the former. In fact you will find that most bipolar people on ADs will also have to use antipsychotics to combat the switching and I hope readers of this blog are all aware of how many often irreversible side-effects are associated with antipsychotics. There are no drugs known to reduce the increased risk of rapid cycling associated with ADs.

However if you do find SSRIs or other ADs helpful, keep in mind that you will have to stop them for at least two weeks before commencing MAOIs and if you decide to switch back you’ll again have to go through a two week washout period.

To anyone tempted to believe that MAOIs are safe I’d suggest you google “MAOI toxicity”.

Check out the sources of the google hits (we’re not talking Fred’s Anti-Meds Blog here) and the seriousness and frequency of the symptoms compared to what you get when you google, say, ‘SSRI toxicity’.

MAOIs also top the list of drugs implicated in serotonin syndrome. That’s because they not only increase serotonin directly, they block the mechanisms that allow the body to eliminate other serotonergic drugs. Even St John’s Wort can cause serotonin syndrome when taken within two weeks of MAOIs.

All I can say at the end of the day is make sure you consult with an experienced medical professional who you trust (biggie).

High-quality medical professionals will take your concerns about the reported dangers of MAOI’s very seriously, and they don’t want to lose their license in a lawsuit either.

If you ONLY look at all the negatives of this medication and examine and obsess about the contraindications and the possible serotonin syndrome this and the two weeks off SSRI’s that, you’ll drive yourself truly nuts….and you’ll still be depressed.

I suppose that puppy vomit takes precedence. Obviously, EVERYONE: psychiatrists only should be prescribing meds for bipolar disorder. Get it. Research all you want, but discuss any changes with your psychiatrist. ANY CHANGES!

I agree with you that psychiatrists (what about psychopharmacologists?) are the ONLY way to go when it comes to bipolar. Thank you, Kitt, for being a true voice of reason. Seriously, you passed the litmus tests of all litmus tests when you impressed my Mom the way you did.

Lucy found a used tampon that I thought I had carefully thrown away, and vomited it, thank God. I have to secure the trash can in the bathroom better (even though it’s up high in there it’s on top of the toilet!!! Lucy must have climbed onto the the toilet seat) as the girls forget to close the door. And Craig.

I can only read bits and pieces of your comment or else I fear that I’ll start yodeling loudly and I’ll scare Lucy and she’ll throw up again.

Regarding your comment “many people would find cutting out alcohol, cheese, fava beans, etc pretty challenging – especially if they eat out a lot. They would also have to be very diligent about checking interactions with other drugs – including things like over the counter cough medicines.”

Imagine a Homer Simpson voice:

“Doh! Uhhhh, what would be a better way of life for me?
Feeling like shit every day, wanting to die, never feeling hope, like I have for YEARS????
Or hey – there’s a FAVA BEAN! Gotta eat it! And a chunk of PROVOLONE!
Scarfing that down is worth FAR more to me than my Alice Cooper nightmare life!!!!”

Most depressed people don’t eat out a lot!
I didn’t. I wanted to die.
I just didn’t tell people that I wanted to die since I had kids and pets and I didn’t want to get locked up again after suffering through 11 hospitalizations.

As far as drug interactions are concerned – all you do is simply call your pharmacist about the drug interactions and the look it up on their system, or you can look them up online as there are tons of free, self-check drug interactions programs available, or do what I do – do both!

I can’t believe these totally wimpy “arguments” you’re producing, especially as I consider you to be brilliant. Is this a test? Do you secretly work for Big Pharma?????

I will SING HIGH & LOW to the mountaintops about MAOI medication.
I have absolutely no qualms about giving people the opportunity to consider it.
They deserve to have the chance to consult with their own medical professional, and go from there.

Perhaps that’s true. But many depressed people don’t cook either. They order take outs.

You wanna go down your list with your average takeaway restaurant, “No cheese, no processed meat, no pickles, no tofu, no soy sauce, etc, etc, etc” and trust that they’ll diligently check their ingredients list?

As far as working for Big Pharma goes, as you know I’m highly skeptical of all psychiatric drugs (though I’m a big supporter of vaccines and antibiotics). The only p-drugs I am more skeptical of than MAOIs are anti-psychotics – which are the single biggest money spinner for drug companies bar none. If you are a bipolar person who takes antidepressants of any kind you are very likely going to need antipsychotics too so a Big Pharma shill would wholeheartedly support your endorsement of MAOIs.

I actually never go to takeaway joints because they’re gross over here. McDonald’s just had a recall of 1000 chicken nuggets as they had plastic in them.

I go to taquerias! Yum.
No problemo con estos!
I just don’t have cheese in my tacos and they still rock!

I can eat pickles (I love pickles) without any reaction, but yeah, they’re on the list – it is something to discuss with one’s medical provider. The list of no no foods varies all over the place, I’ve found, from the Mayo Clinic to CVS Pharmacy to my dr. I’ve learned that it’s fine to eat certain foods that some lists shun – but that’s something to DEFINITELY discuss with your dr.

At first I was so careful that I didn’t eat my favorite mangos and avocados (they’re on many lists) but my dr. said they were fine to eat, and then I started to eat them again. I was aok.

I’m strict about soy sauce, aged cheeses, cured meats and booze. And my body is better off for it. Most people can stand to lose some weight anyway, so this is a good incentive

For those who rely on takeaway, well, you need to change your life. Buy canned foods at the store and yeah – you’ll have to read the ingredients. Again, it’s more than worth the sacrifice. I don’t buy the whiny “Oooooohhhhh, it’s too hard for me” bit.

Dyane, deep breath. You feel passionately about MAOIs, for Parnate worked for YOU. Please distance yourself from this argument online. Do not engage. Arguments take two. Talk to me. Heck, I’ll give you a call.

Definitely not lollies. No meds are. I actually am trying to down my dose of escitalopram from 5 mg to off b/c hypomanic symptoms brought on by longer days. Reduced to 2.5 mg, slept all day. Staying on 2.5 mg for the time being. Cannot make changes too rapidly. Extremely sensitive to changes. Any changes. Like, why am I adding to the discussion. Oh, because you mentioned SSRIs.

Don’t want to diagnose or prescribe here. Just present Dyane’s experience. Good to be fully informed. Remember, folks, we all have different needs and reactions to medication. Only a (BOARD CERTIFIED) psychiatrist has any business prescribing medications for serious mental illnesses. For far too long I saw my neighborhood doc-in-the-box for depression.

I, too, am treatment resistant and have tried everything except an MAOI. Like Dyan, it was never suggested by any pdoc. I’ve been off all meds now for 5 years and limp along the best I can with warp-speed rapid cycling.

I will mention this to the nurse practitioner who does med management at my clinic now, but I’m not very hopeful. I don’t know if I want to go through all that again and come out the other side the same. I’ll have to think hard about this.

Oh…..I didn’t have my hopes up at all for those medications to be effective. I had given up in my mind, and I was just trying to survive and take good care of my kids, you know?

Of course I’m concerned about getting others’ hopes up in vain, but I can’t be silent about this after what I’ve experienced firsthand.

I’d like to hear what your nurse thinks about the suggestion. Also, please don’t be “scared off” by the dietary restrictions….sure, I was bummed to give up some foods/alcohol I enjoy (the pharmacy will give you a list of what to avoid, and there are online resources as well) but that wound up to be completely worth it.

Please remember that I used the MAOI Parnate/tranylcypromine – 10 mg, 3x/ a day for a total og 30mg) in combination with lithium (900 mg/night – everyone has different dosages with lithium but I found through trial and error that 900 works best for me right now).

I know that lithium is yet another medication that can be hit or miss for many people, but it ups the chances of the MAOI working well. I located two studies done in 1970 that showed impressive results from the specific combination of Parnate/tranylcypromine & lithium. The studies were very small, but the results gave me real hope. I’m looking around for the two studies rather frantically right now to no avail, but if I find them later I’ll post the links here. You can also search online too.

Yes, I implore you to give this possibility serious thought. I know you must so so weary from all you’ve endured…I have my fingers crossed if you and your health professional decide to move forward.

Honestly, how expert is your NP in psychiatric medication? I know they prescribe them, but I look for board certified psychiatrists and for my son board certification in child and adolescent psychiatry. Or psychiatrist is both and did his residency and fellowship at UCLA & UCI & ADHD medication trials – perfect for assessing my son & determining that he did not (or no longer) need stimulants. Just saying. Quality care makes a HUGE difference. Unfortunately, few have access to quality care.

This opinion is not directed at Sandy Sue in ANY way – I just thought it and I wanted to share – blame it on the sunshine I’m sitting in -so many in our society will spend tons of money time etc. on a hair stylist or a fancy dinner instead of on her mental health professional. That might make for a blog post, people! Anyone want to take it on? (This also has nothing to do with the underserved who don’t have a choice and/or resources to see a qualified professional.)

Unfortunately, very few people can AFFORD quality medical care. Most highly qualified medical professionals refuse Medicare. Many refuse any insurance. They bill you at hundreds of dollars an hour and expect you to wring your insurance company for some miniscule reimbursement.

Psychiatrists are fleeing Iowa like rats on a sinking ship. Something to do with Medicare. We’re lucky to have a NP who is experienced and listens to patients’ needs. I would have to travel at least an hour and wait up to 6 months to see a pdoc. Since I’m not on meds, this isn’t an issue for me, but I really feel for those who need more care.

No pdocs near here accept Medicare. In fact, they require that you sign a release acknowledging that they do not see Medicare patients. You are on your own if you do not have excellent insurance or the ability to pay out of pocket.

Wow! Fingers crossed. Who knows what “magic combo” ends up working for you. I wish you the best in getting your bipolar under control. Daily cycling must be horrible. I’ve rapid cycled, it can get pretty hairy.

Hey Susan, I just wrote you on Facebook about how thrilled I am about your decision to discuss the meds as a possibility, and I also copied a long comment that I wrote here on Kitt’s blog in response to Cabrogal to make sure you read that!!! XOOXOXX

I’m totally honored that you quoted my comment (excuse the typos! I cringe, I cringe over them!) I I was so excited to see this post that I reblogged it! If I can help one person with bipolar who has never tried an MAOI and then tries it and is helped by it, I will seriously be fulfilled in my lifetime apart from seeing my kids thrive. It’s my mission! Thank you!!

After months of my faithfully posting every Friday, no more, no less, these past few days I’ve been full of blogging & re-blogging excitement! I just can’t help myself, especially when it comes to the topic that my good friend Kitt O’Malley addresses in her acclaimed blog along with an International Bipolar Foundation post written by our our mutual friend Susan Zarit.

I’m on a mission to let people know about a rather “obsolete”, unsung, bipolar medication combination that DID work for to lift my years-long, insidious, evil bipolar depression. None of the numerous psychiatrists I saw ever thought to even mention this med. until my most recent doctor, Dr. D. , who is also the best psychiatrist I’ve ever seen since I was diagnosed with bipolar one disorder in 2007.

In late 2013, per Dr. D.’s suggestion, I started taking an MAOI (monoamine oxidase inhibitor) medication called Parnate, which is an old-school anti-depressant medication. There are a few different MAOI’s and they’ve been used for decades for bipolar-medication resistant patients! Why didn’t any pdoc think to tell me about them before Dr. D. I’d love your take on that one! For the record my father (who also had bipolar one) took an MAOI but it didn’t work for him as he drank alcohol with it, which is a big no no.

Parnate works especially well when used with lithium, which I take and have no problems with – I take 900 mg/night.

I never like to give false hope when it comes to bipolar & meds, but this combination has been nothing short of miraculous in my life. It hasn’t been perfect, there are sacrifices I’ve made (some good, i.e. the alcohol!) but dammit – these sacrifices have been completely worth it. Read on for more info. – and I’ll try not to blog again until my regular Friday. Famous last words….. 😉

p.s. feel free to ask me any and all questions about MAOI’s & if I don’t know the answer I’ll ask my psychiatrist when I see him on Thursday.